Acute pulmonary injury in hematology patients supported with pathogen-reduced and conventional platelet components Journal Article
| Authors: | Wheeler, A. P.; Snyder, E. L.; Refaai, M.; Cohn, C. S.; Poisson, J.; Fontaine, M.; Sehl, M.; Nooka, A. K.; Uhl, L.; Spinella, P. C.; Fenelus, M.; Liles, D.; Coyle, T.; Becker, J.; Jeng, M.; Gehrie, E. A.; Spencer, B. R.; Young, P.; Johnson, A.; O’Brien, J. J.; Schiller, G. J.; Roback, J. D.; Malynn, E.; Jackups, R.; Avecilla, S. T.; Liu, K.; Bentow, S.; Varrone, J.; Benjamin, R. J.; Corash, L. M. |
| Article Title: | Acute pulmonary injury in hematology patients supported with pathogen-reduced and conventional platelet components |
| Abstract: | Patients treated with antineoplastic therapy often develop thrombocytopenia requiring platelet transfusion, which has potential to exacerbate pulmonary injury. This study tested the hypothesis that amotosalen-UVA pathogen–reduced platelet components (PRPCs) do not potentiate pulmonary dysfunction compared with conventional platelet components (CPCs). A prospective, multicenter, open-label, sequential cohort study evaluated the incidence of treatment-emergent assisted mechanical ventilation initiated for pulmonary dysfunction (TEAMV-PD). The first cohort received CPC. After the CPC cohort, each site enrolled a second cohort transfused with PRPC. Other outcomes included clinically significant pulmonary adverse events (CSPAE) and the incidence of treatment-emergent acute respiratory distress syndrome (TEARDS) diagnosed by blinded expert adjudication. The incidence of TEAMV-PD in all patients (1068 PRPC and 1223 CPC) was less for PRPC (1.7 %) than CPC (3.1%) with a treatment difference of –1.5% (95% confidence interval [CI], –2.7 to –0.2). In patients requiring ≥2 PCs, the incidence of TEAMV-PD was reduced for PRPC recipients compared with CPC recipients (treatment difference, –2.4%; 95% CI, –4.2 to –0.6). CSPAE increased with increasing PC exposure but were not significantly different between the cohorts. For patients receiving ≥2 platelet transfusions, TEARDS occurred in 1.3% PRPC and 2.6% CPC recipients (P = .086). Bayesian analysis demonstrated PRPC may be superior in reducing TEAMV-PD and TEARDS for platelet transfusion recipients compared with CPC recipients, with 99.2% and 88.8% probability, respectively. In this study, PRPC compared with CPC demonstrated high probability of reduced severe pulmonary injury requiring assisted © 2024 American Society of Hematology. All rights reserved. |
| Keywords: | controlled study; major clinical study; chemotherapy; prospective study; sensitivity analysis; thrombocyte; bayes theorem; randomized controlled trial; incidence; cohort analysis; hematopoietic stem cell transplantation; pneumonia; health care quality; multicenter study; imaging; pleura effusion; randomization; arterial gas; leukocyte; x irradiation; thrombocyte transfusion; sample size; artificial ventilation; adult respiratory distress syndrome; hematology; cumulative incidence; adverse event; lung injury; clinical outcome; demographics; lung edema; acute lung injury; propensity score; lung insufficiency; Common Terminology Criteria for Adverse Events; human; article; infectious agent; respiratory care; conventional platelet component |
| Journal Title: | Blood Advances |
| Volume: | 8 |
| Issue: | 9 |
| ISSN: | 2473-9529 |
| Publisher: | American Society of Hematology |
| Date Published: | 2024-05-14 |
| Start Page: | 2290 |
| End Page: | 2299 |
| Language: | English |
| DOI: | 10.1182/bloodadvances.2023012425 |
| PUBMED: | 38447116 |
| PROVIDER: | scopus |
| PMCID: | PMC11116994 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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